Delishaj Durim, Barcellini Amelia, D'Amico Romerai, Ursino Stefano, Pasqualetti Francesco, Fumagalli Ilaria Costanza, Soatti Carlo Pietro
Department of Radiotherapy, Alessandro Manzoni Hospital, Lecco.
Department of Radiotherapy, National Center of Oncological Hadrontherapy, Pavia.
J Contemp Brachytherapy. 2018 Dec;10(6):559-566. doi: 10.5114/jcb.2018.79713. Epub 2018 Dec 28.
To evaluate vaginal toxicity (primary endpoint) and local control (secondary endpoint) in patients with endometrial cancer who underwent primary surgery and adjuvant high-dose-rate (HDR) endovaginal brachytherapy (BT).
In September 2017, the authors conducted a comprehensive literature search of the following electronic databases: PubMed, Web of Science, Scopus, and Cochrane library. In this systematic review, the authors included randomized trials, non-randomized trials, prospective studies, retrospective studies, and cases. The time period of the research included articles published from September 1997 to September 2017.
Acute endovaginal toxicity occurred in less than 20.6% and all acute toxicities were G1-G2. The most common early side effects due to HDR-BT treatment were vaginal inflammation, vaginal irritation, dryness, discharge, soreness, swelling, and fungal infection. G1-G2 late toxicity occurred in less than 27.7%. Finally, G3-G4 late vaginal occurred in less than 2%. The most common late side effects consisted of vaginal discharge, dryness, itching, bleeding, fibrosis, telangiectasias, stenosis, short or narrow vagina, and dyspareunia.
The data suggest that HDR endovaginal brachytherapy, with or without chemotherapy, is very well tolerated with low rates of acute and late vaginal toxicities. Further prospective studies with higher numbers of patients and longer follow-up are necessary to evaluate acute and late toxicities after HDR endovaginal brachytherapy.
评估接受初次手术及辅助高剂量率（HDR）阴道近距离放疗（BT）的子宫内膜癌患者的阴道毒性（主要终点）和局部控制情况（次要终点）。
2017年9月，作者对以下电子数据库进行了全面的文献检索：PubMed、科学网、Scopus和Cochrane图书馆。在这项系统评价中，作者纳入了随机试验、非随机试验、前瞻性研究、回顾性研究和病例。研究的时间范围包括1997年9月至2017年9月发表的文章。
急性阴道毒性发生率低于20.6%，所有急性毒性均为1-2级。HDR-BT治疗最常见的早期副作用是阴道炎症、阴道刺激、干燥、分泌物、酸痛、肿胀和真菌感染。1-2级晚期毒性发生率低于27.7%。最后，3-4级晚期阴道毒性发生率低于2%。最常见的晚期副作用包括阴道分泌物、干燥、瘙痒、出血、纤维化、毛细血管扩张、狭窄、阴道短或窄以及性交困难。
数据表明，无论是否联合化疗，HDR阴道近距离放疗的耐受性都很好，急性和晚期阴道毒性发生率较低。需要进行更多患者、更长随访时间的进一步前瞻性研究，以评估HDR阴道近距离放疗后的急性和晚期毒性。
